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Thread: No Platelets!

  1. #1
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    No Platelets!

    Hello everyone! This is a complicated question but I'll try to be brief. Dx with primary breast lymphoma and hepatitis c in Feb 09. Put on Epivir 100 mg. Did 2 rounds of Rituxan and Zevalin. Platelets have been steadily dropping around 5500 daily. Had uterine biopsy due to excessive menstrual bleeding and platelet drop. Stopped bleeding for a couple of days after that but then started bleeding again today. Platelets are now at 8000. Doctor says only platelet transfusion will help. (Zevalin is stopping megakaryocyte production therefore no platelets.) Doc also says proteins will not help situation so he will not try Neumega, Neupogen, cryoprecipite etc.....! I'm a Jehovah Witness and will not receive platelet transfusion. With platelets dropping @ 5500 daily I feel I'm running out of time for rx before I end up with cerebral or abdominal bleed! I'll have zero (0) platelets in 2 days! Suggestions anyone???? Please help!!!!!!
    Last edited by laurie; 04-02-2009 at 06:41 PM. Reason: change in lab work

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  3. #2
    Quote Originally Posted by laurie View Post
    Hello everyone! This is a complicated question but I'll try to be brief. Dx with primary breast lymphoma and hepatitis c in Feb 09. Put on Epivir 100 mg. Did 2 rounds of Rituxan and Zevalin. Platelets have been steadily dropping around 5500 daily. Had uterine biopsy due to excessive menstrual bleeding and platelet drop. Stopped bleeding for a couple of days after that but then started bleeding again today. Platelets are now at 8000. Doctor says only platelet transfusion will help. (Zevalin is stopping megakaryocyte production therefore no platelets.) Doc also says proteins will not help situation so he will not try Neumega, Neupogen, cryoprecipite etc.....! I'm a Jehovah Witness and will not receive platelet transfusion. With platelets dropping @ 5500 daily I feel I'm running out of time for rx before I end up with cerebral or abdominal bleed! I'll have zero (0) platelets in 2 days! Suggestions anyone???? Please help!!!!!!
    Wow. They do say that doctors are the leading cause of death. Maybe they are right!

    Epivir suppresses bone marrow. Severe anemia is listed as a side effect. What good is a low viral load if your hemoglobin is zero?

    Rituxan and especially Zevalin also beats up on the bone marrow. Again, what good is tumor remission if you have bled out?

    The doctor is probably right about the limited effects that Neumega would have. It would be like taking vitamins at the same time one is consuming rat poison. The outcome isn't going to change.

    One approach might be to stop all your medications. Pray that you don't bleed out while the bone marrow starts to recover. Then divide and conquer. Focus on the lymphoma. Hep C takes decades to do it's damage. Lymphoma can lead to death in months.

    There are much less toxic approaches to lymphoma. What is your vitamin D level? Again, if you do not bleed out in the next few days, you will have a little time to research these, get second & third opinions.

    This all, of course, is a personal decision. Hopefully, we will hear back from you as things turn around.

    Joseph T. Malak, MD

  4. #3
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    Laurie,
    I am sorry you are ill. Please also contact your HLC. You will be in our prayers.

  5. #4
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    Hello Doc Malak!

    Thank you for responding back to me. I'm sorry I did not explain myself better in my original post but the lymphoma is gone (or going). Evidently you only do 2 treatments of the Rituxan/Zevalin (3 or more and you are assured of death!) The hepatitis seems to be under control. I never had any symptoms. Liver function is good, so are my enzyme levels. The Epivir was prescribed for a previous exposure to hep b. Supposedly the Rituxan can cause a flare up. Can you think of anything I might try to jumpstart platelet or megakaryocyte production??? Can you explain the vitamin D usage? Maybe vitamin K? Thank you again for your time!

    Laurie

  6. #5
    Quote Originally Posted by laurie View Post
    Hello Doc Malak!

    Thank you for responding back to me. I'm sorry I did not explain myself better in my original post but the lymphoma is gone (or going). Evidently you only do 2 treatments of the Rituxan/Zevalin (3 or more and you are assured of death!) The hepatitis seems to be under control. I never had any symptoms. Liver function is good, so are my enzyme levels. The Epivir was prescribed for a previous exposure to hep b. Supposedly the Rituxan can cause a flare up. Can you think of anything I might try to jumpstart platelet or megakaryocyte production??? Can you explain the vitamin D usage? Maybe vitamin K? Thank you again for your time!

    Laurie

    Sounds more hopeful! A jumpstart would be nice. While Neumega may help, there are side effects with that too.

    Ploysaccharides come to mind. There are a bunch. One popular product is called Ambrotose.

    Vitamin D deficiency is epidemic, especially this time of year. Getting the level back to where it should be may help with the jumpstart too.

    Vitamin K supplements can help prevent bleeding in folks with liver disease or who do not consume leafy greens.
    Joseph T. Malak, MD

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